Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
PLoS One. 2021 Jun 24;16(6):e0253323. doi: 10.1371/journal.pone.0253323. eCollection 2021.
To evaluate the ability of confocal near-infrared reflectance (NIR) to diagnose retrograde microcystic maculopathy (RMM) in eyes with temporal visual field (VF) loss and optic atrophy from chiasmal compression. To compare NIR findings with optical coherence tomography (OCT) findings in the same group of patients.
Thirty-four eyes (26 patients) with temporal VF loss from chiasmal compression and 41 healthy eyes (22 controls) underwent NIR fundus photography, and macular OCT scanning. VF loss was estimated and retinal layers thickness were measured on OCT. Two examiners blinded to the diagnosis randomly examined NIR images for the presence of hyporeflective abnormality (HA) and OCT scans for the presence of microcystic macular abnormalities (MMA). The total average and hemi-macular HA area and number of microcysts were determined. The groups were compared and the level of agreement was estimated.
The OCT-measured macular retinal nerve fiber and ganglion cell layers were thinner and the inner nuclear layer was thicker in patients compared to controls. HA and MMA were detected in 22 and 12 patient eyes, respectively, and in 0 controls (p<0.001, both comparisons). HA was significantly more frequent than MMA in patients with optic atrophy, and agreement between HA and MMA (both total and hemi-macular) was fair (kappa range: 0.24-0.29). The mean HA area was significantly greater in the nasal than temporal hemi-macula. A re-analysis of the 14 eyes with discrepant findings allowed to confirm RMM in 20 eyes (20/34) indicating that OCT detected RMM in 12 and missed it in 8 eyes. On the other hand, NIR correctly detected 18 out of 20 eyes, overcalled 4 and missed 2.
RMM is a frequent finding in eyes with severe VF loss from long-standing chiasmal compression. NIR photography appears to be more sensitive than OCT for detecting RMM and may be useful as screening method for its presence.
评估共聚焦近红外反射（NIR）诊断因视交叉受压导致颞侧视野（VF）丧失和视神经萎缩的逆行微囊性黄斑病变（RMM）的能力。将 NIR 检查结果与同一组患者的光学相干断层扫描（OCT）结果进行比较。
34 只眼睛（26 名患者）因视交叉压迫导致颞侧 VF 丧失，41 只健康眼睛（22 名对照）接受 NIR 眼底摄影和黄斑 OCT 扫描。在 OCT 上估计 VF 损失并测量视网膜层厚度。两名对诊断结果不知情的检查者随机检查 NIR 图像是否存在低反射异常（HA）和 OCT 扫描是否存在微囊性黄斑异常（MMA）。确定总平均和半黄斑 HA 面积和微囊数量。对各组进行比较并估计一致性水平。
与对照组相比，OCT 测量的黄斑视网膜神经纤维和节细胞层较薄，内核层较厚。在患者中检测到 HA 和 MMA 的分别为 22 只和 12 只眼，而对照组为 0 只（均为 p<0.001，两种比较）。在视神经萎缩患者中，HA 明显比 MMA 更常见，并且 HA 和 MMA（总平均和半黄斑）之间的一致性为中等（kappa 范围：0.24-0.29）。HA 在鼻侧半黄斑的面积明显大于颞侧。对 14 只具有差异发现的眼睛进行重新分析，确认 34 只眼中有 20 只（20/34）患有 RMM，表明 OCT 检测到 12 只 RMM 而漏诊 8 只。另一方面，NIR 正确检测到 20 只眼中的 18 只，过度检查了 4 只，漏诊了 2 只。
在因视交叉长期受压导致严重 VF 丧失的眼中，RMM 是一种常见发现。NIR 摄影术似乎比 OCT 更敏感，用于检测 RMM，并且可能作为其存在的筛选方法有用。
